28
29
Periodic examination
Complete examination checklist
To access the Re-Certification Check Sheet scan the QR code
or visit https://bit.ly/3MGwnj7
9
MSA
Workman Tripod
(Confined Space Entry Kit)
Re-Certification Check Sheet
Equipment record
1 of 2
Competent Person Maintenance Recertification checklist Version 001-Oct19
MSA
safety.com
Examination Checks: Tripod
Item
Description
Pass
Fail
Advisory
1
Examine tripod carrying bag. Fasteners, carrying sling
P
F
A
2
Labels and markings, legible,
in service date.
P
F
A
3
Tripod Head complete, deformation, corrosion, impact damage.
P
F
A
4
Tripod Head x 4 Swivel Eye Bolts. Deformation, corrosion, level of wear.
Fixings x 2 flat washers Ny lock nut with thread protrusion. No modification.
P
F
A
5
2-piece tripod legs x 3. deformation, corrosion, impact damage. Tethered
leg adjustment bolt, Hog ring. Examine alignment and wear of adjustment
apertures.
P
F
A
6
Tripod feet x 3
deformation, corrosion, fixings, pivot freely. Foot pads level of
wear and secure.
P
F
A
7
Tripod leg base strap wear and cam buckle serviceability.
P
F
A
8
Leg performance smooth leg adjustment, locking into place, adjustment bolt
engagement.
P
F
A
9
Complete recertification check sheet.
Y
N
Comments
Item
Action
Model:
P/N 10153101
Customer
Ref No:
Date of Manufacture
Contact
Details
